RCxRules helps healthcare organizations improve RAF scores through increased HCC capture/re-capture rates. Our HCC coding automation software increases coder productivity by identifying high-value encounters with HCC coding gaps. This reduces the coding burden on providers allowing them and coders to focus on what they do best—deliver quality care and perform accurate risk adjustment coding.
Integrating with leading EMRs and PM systems, our software ensures initial claims have the most accurate HCC data—every time, guaranteed.
Providers aren’t coders—let them focus on patient care and have coders do what they do best. Your physicians work diligently to treat patients and document their conditions in their clinical notes. Turning this wealth of information into the correct coding requires the specialized skill set of coders. Our automated coding workflow eliminates the need to manually review every claim, enabling HCC coders to work with maximum efficiency.
Retrospective chart reviews have been a necessary fact of life for groups addressing their HCC coding challenge. But this process is redundant, manual, and expensive. RCxRules’ automated, concurrent coding workflow reviews 100% of your HCC encounters, flagging errors before they are submitted as a claim, not after. Let your coders focus only on the encounters that require their attention.
Make sure your patient-centered physicians are properly paid for the cost of providing excellent care. Since RAF scores drive the reimbursement in value-based programs, getting the HCC coding correct is critical to ensuring you are compensated appropriately (especially for those high-touch patients that require extra time and attention).
Providers are busy—their time is valuable and in short supply. They respond well to data, but only if it is timely and relevant. Traditionally, data and trends are compiled with a one or two month lag and often lacks details needed to effect process change. Since RCxRules manages the HCC coding process in real-time, you can give your providers information on their coding performance and documentation accuracy in the moment.
The RCxRules engine integrates with your EMR and revenue cycle management systems to verify HCC coding data before claim submission. Correct HCC encounters pass through automatically, while those needing review are sent to your coders to be resolved. We take rich data sets from your existing systems and turn them into actionable insights within the coding workflow to eliminate the need for redundant, retrospective review. Our HCC coding solution workflow consists of:
Whether you rely on RCxRules, or an existing EMR or population health solution, it’s critical to identify your high-risk patients prior to their appointments and to prepare providers ahead of their visits for recapture opportunities.
After the patient visit, RCxRules ensures 100% of encounters are automatically evaluated for diagnosis accuracy and completeness. Then, only those encounters with coding gaps are flagged and routed for coder review before being submitted as a claim.
Providers need real-time insights into their coding patterns and documentation accuracy. Timely and relevant data is essential to meaningful physician engagement and measuring the financial impact of your HCC coding team.